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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

Traumatic Brain Injury and PTSD: Everyone is Vulnerable

Allan N. Schwartz, LCSW, Ph.D. Updated: Jan 4th 2009

 As a result of the wars in Iraq and Afghanistan, there is a tendency to think of traumatic brain injuries being suffered by soldiers exposed to blasts in Iraq and Afghanistan. There is no question that, due to the nature of these two wars and the role played by roadside bombs and suicide bombers, our soldiers are suffering TBIs in numbers equalled by many other wars. However, it is also true that civilians at home in the United States also suffer from TBIs caused by a diverse number of accidents. For example, here in the United States, such things as auto and bicycle accidents, falls from ladders, play on the football and baseball fields, motorcycle crashes and any and even slipping and falling on a banana peel can also cause TBI.

What is Traumatic Brain Injury?

Traumatic brain injury (TBI) is precisely what it says it is. As a result of a trauma, the brain is injured. This injury can be caused either by something penetrating the skull and harming the brain or from any type of blunt force trauma that causes the skull to hit something hard, causing the brain to hit up against the skull.

TBI can be mild, moderate or severe in nature. The odd thing is that those people suffering moderate to severe types of injuries have a better chance of full recovery than those with mild injuries. Moderate to severe injuries often cause unconscious and even comatose states. With rapid medical intervention, the head is stabilized and any additional harm to the head is prevented. When the person regains consciousness, they often have no memory of what caused the accident or of the accident itself. Eventually, they are able to return home and to work.

It is the mild type of TBI that is most often suffered by soldiers and civilians. The injury may or may not result in a brief loss of consciousness. However, after recovery, patients suffer from a wide variety of symptoms from neurologic and psychiatric conditions, including Alzheimer's-type dementia, aggression, memory loss, depression, and Parkinson-like symptoms. In addition, these patients experience Post Traumatic Stress Disorder(PTSD). It is also known that many TBI patients experience "simple" or partial seizures such as found in people with epilepsy.  Depending on the part of the brain affected by the injury, these patients may have memory lapses, imaginary voices, bursts of anxiety and other emotional and cognitive oddities.

Whether war veterans or civilians suffering from TBI treatment includes anti seizure medications along with anti depressants and cognitive behavioral therapy, particularly for the PTSD.

A Personal Note:

I continue to be amazed and troubled by a small number of people who debunk post traumatic stress disorder, particularly with regard to our war veterans. A few comment posted here at Mental Help Net have stated that the veterans are falsifying their symptoms so as to collect disability from the armed services. While there are always going to be a few unscrupulous people who take advantage of the system to commit fraud, by and large, most suffers veterans with PTSD are genuine in their disability. The same holds true for civilians who have suffered head injuries resulting in both TBI and PTSD.

Cautionary Note:

This is why it is important for those who ride bicycles, motorcycles, and who do such things as skate board and engage in other sports activities, to wear protective head gear. I see many motor cycle riders who defy death by not wearing helmet. These men and women seem to be in denial about the fact that there are fates worse than death. Head injuries resulting in TBI and worse(a vegetative state) are fates that can be worse than anything they ever imagined.

It is important for everyone to break through their own denial and wear seat belts when driving and other protective gear when engaged in other activities that can lead to head injuries.

Your comments are welcome and encouraged.

Allan N. Schwartz,PhD

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    mild Traumatic brain injury - Fiona Rouse - Oct 13th 2010

    I was interested in Dr.Schwartz,that it can be harder for a person to recover from a mild traumatic brain injury than a moderate to severe.I would like more info from this Doctor as I have a M.T.B.I. and it's been well over a year and I feel the effects

    PTSD TBI and Life - Ron - Aug 10th 2010

    Hi All, I was involved in a head on car crash at 100KPH a year ago today, basically my personality has changed dramatically with anger, emotions, focusing, memory loss, eyesight deteriation, dizzyness, lack of hand control, lack of sexual fulfilment plus a heap of other stuff as well. The problem is that I have had no treatment in any form and I have just had an MRI to see what if any brain damage I may have. I appear to have all of the symtoms of TBI and PTSD but only knew that I had when looking up on the net now. My life has changed so much in that I have not been able to work since the accident and I am in fact now a domesticated male who used to be The head honcho who also worked hands on in a real estate development and building company. Life is certainly different and the fact that i know I have these limitations is so frustrating when I did so much before the accident. Good luck to all who do not get proper recognition to thier plight and I will refer anyone who needs to know more to this site.

    Mild TBI may be worse - - Jan 10th 2010

    What you said about mild TBI possibly being worse is very true. Two years ago I was struck by a car making a left turn. It was not a high speed accident, but I went right up onto the hood and struck my forehead on the windshield before she saw me. I was thrown /rolled about 20 feet down the road when she hit the brakes. I never lost consciousness and though I was of course a bit shocked and in pain I was together enough to give instructions for contacting my family and by the time the ambulance arrived I was joking with the attendants. I was released after a short examination.

    It wasn't until hours later at home, when my family left me alone to lie down that I noticed I felt nothing. I was completely apathetic. The emails I sent out in the weeks that followed were full of spelling and grammar mistakes, as well of word substitutions (like "at" for "to" etc). I could barely read and could barely do my job. Previously, I had trained people on the computer system I couldn't figure out anymore. I was forgetful, daydreamy, and began to have periods of extreme anger with nausea. I didn't have fear or panic nor any problem going back to the place I was hit. I went back as soon as I felt able physically.

    I had NO PTSD symptoms at all, yet the Neuro-psychiatrist could find "nothing wrong' with me by the time I got an apt 11 months later. He wrote in his conclusions that I was neurotic.  Funny....I was not neurotic the day before the car hit me. I believe the impact of MTBIs with no loss of consciousness is vastly misunderstood by so called experts and that people are mislabelled with PTSD because it's a wastebasket diagnosis for Neuro-psychologists who are ignorant.

    Please note that I am NOT saying PTSD is a fake diagnosis. It is very real and I had it due to an abusive relationship. SOME of the symptoms are similar or overlap but some are very different. I had no trouble spelling or reading with PTSD. If doctors were willing to listen, they could differentiate between them....they just don't listen.

    TBI is the worst - Anonymous - Jan 2nd 2010

    Your statement: "Head injuries resulting in TBI and worse(a vegetative state) are fates that can be worse than anything they ever imagined" is so very, very true in my case.

    I was an extremely active person - going into law enforcement and working out 4 times a week at the gym - I also had my own schedule as a freelance writer, and I read every day.

    It all came to a halt the day my car was found dangling from a 200-foot cliff by an off-duty paramedic. I had either gone to sleep / or gone unconscious. Either way, I don't remember the accident and so the postraumatic amnesia has lasted over a year.

    Since then, I was medically diagnosed with a subdural hematoma, fractured skull, concussion, axonal shearing, whiplash, 3 broken ribs, PTSD, and panic disorder. I also cannot move much because my back has been severely hurt in the accident (they didn't MRI it - so I don't know what is wrong with my back. However, they did MRI my head and found 3 lesions that the neurologist said may spread and grow to paralyze my lungs (instant death) or paralyze me - to some extent (what extent, I am not sure).

    Obviously this has become a great burden on my life as well as loved ones. I need a great deal of support - even sometimes needing assistance to get out of bed. For someone so active as myself before, it breaks my heart to see my own body in this condition ... I have a limited amount of choices each day - such as watching TV - because I'm pretty much unable to do a lot of the things I used to do. My eyed were injured (possibly permanently, the eye dr. said) from the accident, therefore reading and any eye strain of any kind is almost out of reach. I have read one book since my accident - I considered it a miracle because I had to re-learn to read all over again.

    I have to say I've considered suicide; I know in the society we live in thats a "bad" thing but sometimes the pain and the people that don't believe me or think I'm "retarded" because I tell them I'm head-injured just get to be too much to bear; and so does being a prisoner in my own home...

    I think the panic and anxiety are the worst, because if I lost my one support person (my husband) I wonder how on earth would I make it?... I have no income of my own; I was told not to work by my doctors; I cannot even get out of my bed some days; and I can't take care of things in my own life the way I used to.

    If anyone has ANY advice (especially about calming the panic) please write / email. Thank you very much.

    thank you - chris - Sep 6th 2009

    My husband, an OIF veteran, suffers from both severe PTSD and TBI.  I also suffer from TBI from a career teaching fighting.  Thank you for this article as he has recently started having mild seizures.  To know it's a symptom eases the worry and lets me know we may not have another problem on our hands.  Thank you.

    Traumatic Brain Injury - Julian Roberts - Jul 23rd 2009

    Thanks for the post and specially focusing on TBI. Yes, there is nothing more disastrous than sustaining a brain injury. Brain injury is totally different from other injuries as it cannot be seen and treatment without seeing is really complicate. Besides the process of treatment is lengthy. It may take few years or it may take several years to cure brain injury depending upon the injuries (major and minor).  Sometimes Traumatic Brain Injury may result in coma and even death. Most brain injury victims die due to negligence and unawareness. Traumatic brain injuries can be cured if proper treatment is given from the initial stage.

    There has to be a full night's sleep - Deborah A. Romer, - Apr 18th 2009

    My accident was 15 years ago. I was a Nurse prractioner. I was struck by vehicle at redlight going 55-60 m.p.h. Rarely do I get a full night's sleep. H.S. I take 10 diazapem,50 chlorthiazepoxide,25 diphenhydramine. I sleep between 2 to 4 hours & then I am very awake,have white sounds in room,listen to lazy music, do something boring like dust. Two hours and I feel sleepy enough again to sing childhood hymns in my head. I then sleep for three more hours. I am now 65 years of age. This routine is exhausting. Tried Neurontin & had anaphylaxis. Took peds dosage Dilantin and I was feeling very well, except H.S.,I reminded myself of a Meth head, or Crack head. I was ready, for what I don't know because physically I was ex-hausted. I am an up person in the day. Live in Senior apts. & volunteer death & dying. I would love to sleep, this is 1st year I have nightmares of the lady who was passenger in other car coming thru windshield. Last vision before lost consciousness. I wanted to help her,debride the glass, but I was not there. I recently read: Restoril,Cymbalta, & diazepem. Would appreciate any info. I am not in my original state of FL.,but Mo. after Katrina.                                              Thank You,Deborah A. Romer

    PTSD is Real - - Jan 13th 2009

    I was physically and emotionally abused as a child and shamed when I couldn’t live up to my parents expectations. My older brother had a violent temper and I was often on the other side of his fists and demands. There have been other traumatic events in my life, including being severly bullied at school and just living in an environment of fear. I was never on any medication until 2-years ago when I witnessed a crime that could have cost me my life. I’m now on five medications to help control my severe PTSD, Panic attacks, Panic Disorder and Social Anxiety disorder. Believe me, PTSD does exist and sure as heck wish that it didn’t. If you know of anyone who has been diagnosed with PTSD, know that their suffering is real.

    ptsd and dissociation - - Jan 6th 2009

    I am a young nurse that suffers from ptsd and dissociation. I was sevevely abused a a very young child until I was age 12. My parents new but wanted to keep the family together. It was a non biological uncle. Who lives 3 blocks from me. I have great trouble being with men. I was married for 5 years had two boys and then divorced. I really can't remember my marriage because I was not not present. I have been seeing a wonderfull female therapist who seems to be helping me cope with the dissociation. I lose myself often. I have nightmares often and I use my treadmill to run myself away from these dreams. I would appreciate anything you have to offer.                                                       Thanks   bronxtail

    Post Trauma from childhood beatings - - Jan 5th 2009

    Can after 43 years , can your brain still be affected by blows to the head inflicted by an abusive parent?  Does post traumatic injury apply to this? And if it does , what would the end results to all this be?

    Editor's Note: Physical brain trauma from childhood beatings could have (but certainly may not have as well) resulted in permanent brain injury which could affect a person for the remainder of their lifespan.  If this were the case, you'd expect to be troubled by symptoms that are characteristic of brain injury, less than symptoms characteristic of PTSD (although there is certainly some overlap).  The same beatings you received in childhood may possibly also and separately have given rise to emotional trauma which could (but may not have) manifest in adulthood in the form of PTSD style symptoms.  The likelihood is that such childhood emotional trauma would not be diagnosed as PTSD, however, but instead as something else such as possibly, borderline personality disorder (BPD). Physical trauma and emotional trauma can share the same cluster of symptoms, which may include difficulty concentrating, and difficulty with emotional control.  However, physical trauma will not generally produce symptoms that are near universally a product of emotional trauma such as repetative flashbacks that force you to relive the traumatic event.  This is a complex question, actually, and the answer is necessarily complex.  

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